Individual
DR. CHARLES H ANTINORI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1102 E CHESTNUT AVE, VINELAND, NJ 08360-5002
(856) 213-6375
(856) 575-4986
Mailing address
2848 S DELSEA DR, SUITE 4B, VINELAND, NJ 08360-7042
(856) 205-7070
(856) 205-0145
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
25MA03721000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2041502
—
NJ
01
—
P00104418
RAILROAD MEDICARE
NJ
Enumeration date
10/13/2005
Last updated
09/10/2012
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